We thank Dr Carra for his comments[1] and we appreciate his attention
to
our work.[2]
Our paper was directed to a method for ranking potential safety
problems that merit additional statistical and engineering review. We
envisioned a surveillance process to develop a rank ordered problem list.
A follow-up review process should start at the top of the problem list
and work down through it,...
We thank Dr Carra for his comments[1] and we appreciate his attention
to
our work.[2]
Our paper was directed to a method for ranking potential safety
problems that merit additional statistical and engineering review. We
envisioned a surveillance process to develop a rank ordered problem list.
A follow-up review process should start at the top of the problem list
and work down through it, as resources permit. Problem ranking with
our proposed statistic minimizes the "false positives" issue as it pushes
these toward the bottom of the list. We understand this does not
eliminate the issue. The only way we know to do that with certainty is to
get rid of the surveillance.
We have never assumed that all relevant crash "factors" are coded
perfectly in FARS and we said so in our conclusions. Throughout
the paper, we also emphasized the relevance of this method to datasets
other than FARS.
Like any good diagnostic test, the proposed methodology should be
evaluated by a proven ability to detect a known issue early. That is why
we studied an acknowledged problem. The FARS data show other
potential issues of concern that were unknown, at least to us. See, for
example, the fatal vehicle fire data shown in Figure 4.
Dr. Carra's letter points out that the first data from the agency's
Early
Warning Reporting system has been received by NHTSA and are currently
being analyzed. The public may not be aware that these data for deaths,
injuries, and property damage are currently being withheld from public
health researchers outside the agency. As our paper points out, secret
data were an essential ingredient in the original tragedy and ensuing
scandal. This lesson seems not to have been learned.
Our proposed method to improve defect-related surveillance would have
worked well to identify the Ford Explorer tire problem as a high priority
concern for the agency. Our paper demonstrates this could have been
known long before so many deaths and injuries resulted. See Figure 1.
Reference
1. Carra J. Unwarranted Assumptions about FARS data [electronic response to Whitfield and Whitfield; Improving surveillance for
injuries
associated with potential motor vehicle safety defects] injuryprevention.com 2004http://ip.bmjjournals.com/cgi/eletters/10/2/88#74
2. R A Whitfield and A K Whitfield. Improving surveillance for
injuries
associated with potential motor vehicle safety defects. Inj Prev 2004; 10:88-92.
The article of Dr. Stevenson's is very interesting. This article showed
that intervention increasing the use of safe belt. Traumatic brain injury
is one of the most leading causes of death and disability in developing
countries. In Indonesia, there are numerous reports that showed high
mortality is correlated with unsafe practice of driving or motorcycling.
Previous report showed that the use of safety belts is the single...
The article of Dr. Stevenson's is very interesting. This article showed
that intervention increasing the use of safe belt. Traumatic brain injury
is one of the most leading causes of death and disability in developing
countries. In Indonesia, there are numerous reports that showed high
mortality is correlated with unsafe practice of driving or motorcycling.
Previous report showed that the use of safety belts is the single most
effective means of reducing fatal and nonfatal injuries in motor-vehicle
crashes. Previous review from Shults et.al. showed that primary safety
belt laws and enhanced enforcement programs tend to result in greater
increases in usage rates for target groups with lower baseline rates.
Previous reviews also showed that interventions which combine education
with either incentives or distribution of free booster seats have a
beneficial effect on acquisition and use of booster seats for children.
This is a simple way for saving more lives.
References
Shults RA,Nichols JL, Zarr DC, Sleeta DA, Eldera RW, Effectiveness of
primary enforcement safety belt laws and enhanced enforcement of safety
belt laws: A summary of the Guide to Community Preventive Services
systematic reviews, Journal of Safety Research, 2004, 35(2;)189-196
Magnussen L, Emusu D, King W, Osberg JS. Interventions for promoting
booster seat use in 4–8 year olds traveling in motor vehicles. The
Cochrane Database of Systematic Reviews 2006, Issue 1.
Our critics argue two points. First, they argue that
newspapers are an inappropriate source of data on
defensive gun use (DGU) because editors routinely
and deliberately suppress stories of legitimate DGU
that involve killing or wounding or firing at an adversary.
(Some of these writers also argue that brandishing a
gun in self-defense is even less likely to be reported in
the newspaper because these...
Our critics argue two points. First, they argue that
newspapers are an inappropriate source of data on
defensive gun use (DGU) because editors routinely
and deliberately suppress stories of legitimate DGU
that involve killing or wounding or firing at an adversary.
(Some of these writers also argue that brandishing a
gun in self-defense is even less likely to be reported in
the newspaper because these cases most often do not
even become known to police. However, this point is
irrelevant to our study because we only assessed DGU
killings, woundings, and firings.) It is incumbent on
these critics to provide the evidence to support their
claim. Merely citing examples (such as the case of
Peter Odighizuwa) where news stories left out mention
of a gun being used in self-defense is not enough.
They need to show that the degree of editorial bias is
enough to account for the results we found. In the
newspaper we used, the editors would have had to
have suppressed more than one story per day of DGU
killing or wounding that the police knew about (if Kleck
and Gertz’s [1] rates are accurate). When we began the
study we asked and were told that there was no
editorial policy not to print stories of DGU killings and
woundings. Because it is obvious that the newspaper
does not report all stories of woundings by gun, we
also asked specifically about stories involving citizens
wounding assailants in self-defense, and we were told
there would be “a high probability they would be
reported in the paper.” We checked the rate of DGU
killings reported in the newspaper and found it
compared favorably to the rate of justifiable homicides
in the Uniform Crime Report (there is no comparable
report of “justifiable woundings”). What these critics
need is data from the following kind of study: a survey
of the daily police operations reports to identify cases
that appear to be DGU, and a determination of the
percentage of those that are reported in the local
newspaper (not USA Today). We are not aware of any
such study, but would be happy to learn if one exists.
Second, they argue that we cannot establish the
true rate of DGU from newspaper reports. This point is
a strawman because nowhere in our paper do we
attempt to do so. Instead, we used newspaper reports
as a "reality check" on Kleck and Gertz’s rates, and
found that if their rates are accurate then 98% of the
DGU killings and woundings that the police knew about
went unreported in the newspaper. We leave it to
readers to decide which is more plausible, that Kleck
and Gertz’s rates are too high or that so many known
cases are kept out of the newspaper. Note that Kleck
and Gertz combine the categories of DGU killings and
DGU woundings. A very straightforward assessment of
the accuracy of their telephone survey would be to
separate out the rate of DGU killings and compare it to
the rate of justifiable homicides in the Uniform Crime
Report. We have asked Professor Kleck for this
breakdown and are awaiting his response.
Reference
1. Kleck G, Gertz,M. Armed resistence to crime: the
prevalence and nature of self-defense with a gun.
Journal of Criminal Law and Criminology 1995;86:150-
87.
Several analyses of the results of bibliographic databases have shown
that--for several health fields and subjects--the number of databases
searched influences the number of papers found. Library and information
scientists seem to use certain methods and outcomes in their analyses. I
am curious whether this study used the same methods and measures.
To focus on injury mitigation in cyclists to the exclusion of
addressing the causes of crashes, as is the trend in public debate at
present,[1] risks fundamental errors - not least the post hoc fallacy of
assuming that cycling head injuries are the result of failure to wear
helmets, rather than of the types of crashes cyclists experience.
As a result of this obsession we have arrived at the ab...
To focus on injury mitigation in cyclists to the exclusion of
addressing the causes of crashes, as is the trend in public debate at
present,[1] risks fundamental errors - not least the post hoc fallacy of
assuming that cycling head injuries are the result of failure to wear
helmets, rather than of the types of crashes cyclists experience.
As a result of this obsession we have arrived at the absurd position
where the death of a child cyclist is publicly attributed not to the fact
that he rode off the pavement into traffic on a bike with defective
brakes, but to the fact that when he did so he was not wearing a helmet.
Recent analysis of Department of Health data on child hospital
admissions for England for the period 1995/96 to 2002/03[2] showed that:
the proportion of head injuries in child cyclists on the road is
hardly different from that of child pedestrians (49% against 46%, with
helmet wearing rates of 15%[3])
the risk of head injury in off-road cycling is an order of
magnitude lower than in road cycling;
cycling is far from being the leading cause of head injury
admission, being behind trips and falls and even assault.
Why is it, then, that cycling is seen as a uniquely dangerous
activity, when a dispassionate look at these and many other statistics
indicates very clearly that it is not? There are probably a number of
factors at work:
head injuries raise the spectre of intellectual disablement, which
of course cannot be "fixed" by modern medicine, even though this is very
rare - the fact that such injuries are now thought to be mainly the result
of rotational forces which helmets do not mitigate (and may even
aggravate) adds a touch of irony
even trivial head injuries can bleed spectacularly, which combined
with the fear factor, and justifiable anxiety over the cosmetic outcome,
increases the likelihood of attendance at A&E “just in case”, even
though in most cases treatment is limited to basic first aid - so that
nurses, for example, "see a lot of cycling head injuries";
there exists a substantial industry whose expensive product will
not sell unless a culture of fear is maintained, and the protective effect
of its product "sexed up" - few people would spend the price of a modern
helmet if they were told bluntly that they are tested only for the
equivalent of a fall from a stationary riding position, yet this is the
literal truth (note the wide disparity between claims made by
manufacturers and by helmet advocacy groups, who still quote as gospel the
flawed 1989 Thompson, Rivara and Thompson study,[4] despite well-
documented and acknowledged criticisms[5])
the culture of fear extends in particular to the danger of motor
traffic, with some justification as the estimated 10% of child cycling
which is on-road results in half of all child cyclist admissions and
almost all the deaths
there is a false belief that nothing can be done about the source
of this danger (i.e. drivers cannot be made to drive more carefully), and
no amount of riding skill can reduce the danger; but cycle trainers report
widespread ignorance of riding techniques which can avert many of the more
common sorts of crash[6], and surely only political will is lacking in
challenging driving behaviour
fundamentally, most of those campaigning for helmets are not
cyclists and have little understanding of the vast range of different
activities and scales of risk which that term encompasses - it is as if
all outdoor activity from afternoon walks in the park to free-climbing
were considered under a single umbrella.
There is a pressing need to return debate to the sources of danger,
and means of its reduction. Motor vehicles account for around a tenth of
child injury admissions but half of all injury fatalities[7]. This
increased risk is shared by cyclists, (far more numerous) pedestrians, and
motor vehicle occupants. The danger is inherent in the source, not the
victims’ activities, and no proper study of head injury in cyclists should
ignore this fact.
It is also time to recognise that opposition to helmet compulsion,
and to a lesser extent promotion, is not purely libertarian, but based on
robust evidence. As road safety minister David Jamieson recently
acknowledged, the Government knows of no case where cyclist safety has
improved with increasing helmet use. There can be no justification for the
continuing dominance of the cycle safety agenda by this single issue.
Most importantly, the principal indicator for cyclist safety is
numbers cycling.[8] By deterring participation,[9] helmet promotion may
actually reduce safety, in the name of mitigating a minority of those
injuries cyclists may experience.
Perhaps if we all slowed down and drove more carefully the perceived
need for helmets would evaporate - along with the terrible toll of road
traffic fatalities.
References
For example: 1. Sheikh A, Cook A, Ashcroft R. Journal of the Royal Society
of Medicine 2004;97:262-265
2. Data provided to CTC, the national cyclists’ organisation, by the
Department of Health
As noted in the recently released WHO and UNICEF World Report on
Child Injury Prevention, globally, road traffic injuries (RTI) are the
leading cause of death among 10-19 year-olds with more than 260,000
children dying from RTIs each year. (1) In addition, an estimated 10
million more children are non-fatally injured. Africa has the world's
highest RTI mortality rate at 28.3 per 100,000 (2), yet relatively few
resources...
As noted in the recently released WHO and UNICEF World Report on
Child Injury Prevention, globally, road traffic injuries (RTI) are the
leading cause of death among 10-19 year-olds with more than 260,000
children dying from RTIs each year. (1) In addition, an estimated 10
million more children are non-fatally injured. Africa has the world's
highest RTI mortality rate at 28.3 per 100,000 (2), yet relatively few
resources and attention are given to the prevention of RTI in Africa; the
dearth of information regarding the impact and cost-effectiveness of
injury-prevention interventions on the continent is staggering.
Amend.org is a non-governmental organization that focuses on road
traffic safety for children in sub-Saharan Africa. Programs include media
outreach, the distribution of reflective material to school children, and
the teaching of road traffic safety courses in primary schools. The
results of pre- and post-program evaluative tests in five sample primary
schools in Ghana showed improved levels of student understanding of road
safety strategies. This education initiative, called Be Seen, Be Safe, has
been introduced to over 30,000 school children in Ghana and plans are
underway to introduce it in Tanzania in the coming months. An additional
program included a seminar on RTI issues conducted for the media in the
Ghanaian capital, Accra. Journalists and editors from 28 newspapers,
representing approximately half of the country's newspapers attended.
Comparison of newspaper articles on road traffic safety collected three
weeks prior to the workshop compared with six weeks after the workshop
showed an increase of 20% for numbers of commentaries and informational
stories relating to RTIs. Clearly, the need for greater public education
and awareness was recognized by the journalists and editors.
As the evidence mounts about the major public health epidemic
resulting from RTIs, especially in Africa and other developing countries,
promising efforts such as those undertaken by Amend.org must be encouraged
and expanded. However, we urge that all programs be developed in
collaboration with local stakeholders and undergo rigorous evaluation to
assure their effectiveness.
1 In: Peden M, Oyegbite K, Ozanne-Smith J, et al, eds. World report
on child injury prevention. 2008.
http://www.who.int/violence_injury_prevention/child/injury/world_report/en/index.html.
(accessed Jan 8, 2009).
2. In: Peden, M; Scurfield, R; Sleet, D; Mohan, D; Hyder, AA. World
report on road traffic injury prevention. Geneva: World Health
Organization; 2004. Available:
http://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/.
(accessed Jan 8, 2009).
Jeffrey et al's [1] evidence of a serious underestimation of road
injuries is worrying for the year-by-year comparisons that are taken as
evidence for the state of road safety. The UK figures for death and
serious injury are reported to have followed a downward trend for forty
years or so, which has generally been taken as evidence - if no more than
implicitly - that a culture of safety on the roads i...
Jeffrey et al's [1] evidence of a serious underestimation of road
injuries is worrying for the year-by-year comparisons that are taken as
evidence for the state of road safety. The UK figures for death and
serious injury are reported to have followed a downward trend for forty
years or so, which has generally been taken as evidence - if no more than
implicitly - that a culture of safety on the roads is steadily developing
[2]. However, Jeffrey et al's study raises the issue of just how much
change there has been in the standards of recording casualties over the
years. It follows also that the proposing of explanations for the reported
changes must be guarded.
Even overlooking this last point, the safety-culture argument is
itself unconvincing. We well know that there are persistent problems
concerning, for example, speeding, drink-driving and "jumping" level
crossings, along with more recent issues of drugs and mobile-phone use.
Regarding speeding, it is estimated that 50% of drivers exceed the limit
on urban and suburban roads [3].
Alternative factors to explain the falling casualties include the
following: (a) NHS spending on trauma care, by which the consequences of a
given level of trauma are less serious than previously; (b) increasing
cases of road congestion, which lowers speed and the incidence of
overtaking, and hence the severity of crashes; (c) the avoidance of the
road by vulnerable road users [4]. This last issue is coupled with the
high rates of reported pedestrian casualties in Britain [3]; evidence from
Scotland suggests that children in the lowest socio-economic classes are
particularly at risk [5]. In the light of Jeffrey et al's evidence that
casualties among cyclists have been most affected by underestimation, with
pedestrians also notable in this regard, vulnerable road-users seem to be
getting a worse deal than the official figures suggest. Furthermore, there
are the health issues of a society that has become inactive through its
heavy dependence on cars.
If walking and cycling are really to be developed to the level that
applies for example in the Netherlands and Denmark - and bearing in mind
the importance of walking and cycling for accessing public transport -
there is much work to be done in Scotland, and by extrapolation across the
UK as a whole.
References
1. Jeffrey S, Stone D H, Blamey A, et al. An evaluation of police
reporting of road casualties. Injury Prevention 2009; 15: 13-18.
2. Donneley R R (2008). Scottish road strategy: Consultation
document. Edinburgh: The Scottish Government.
3. Department for Transport (2008). Road safety compliance
consultation. London: TSO.
4. Reinhardt-Rutland A H, Thomson J, Foot H, Elliott M (2008).
Response to the Scottish Government consultation: Scottish road safety
strategy. Leicester: British Psychology Society.
5. White D, Raeside R, Barker D (2000). Road accidents and children
living disadvantaged areas. Edinburgh: The Scottish Government.
We are grateful to Annan for spotting the arithmetic error in the
discussion section of our paper of trends in cyclist head injuries.[1] It
would be a mistake, however, to allow a minor mistake in the discussion to
divert attention from the main finding of the paper, which was that
cyclist head injuries fell during a time of increased helmet wearing.
Population level time trend studies are limited in the am...
We are grateful to Annan for spotting the arithmetic error in the
discussion section of our paper of trends in cyclist head injuries.[1] It
would be a mistake, however, to allow a minor mistake in the discussion to
divert attention from the main finding of the paper, which was that
cyclist head injuries fell during a time of increased helmet wearing.
Population level time trend studies are limited in the amount of inference
that can be drawn directly from them, but they nonetheless remain a useful
strand of information that reinforces the findings of the case-control
studies[2] and other population studies[3] showing cycle helmets to be an
effective health intervention.
In response to the comments of Chapman,[4] the accident figures are
difficult to interpret since any comparison between the crude injury rates
of pedestrians and cyclists requires some denominator measure of how much
of each activity takes place. Chapman makes some interesting observations
about the high profile of cycling injuries, and it is indeed a shame that
cycling is perceived as a dangerous activity, but to suggest that
advocates of cycle helmets promote this fear is fallacious. We would also
like to point out that the assumption that those campaigning for cycle
helmets are not cyclists themselves is completely unfounded; one of us
(AC) is a highly experienced cycle tourist and commuter and a long-
standing member of the London Cycling Campaign. We also both encourage
our children to cycle – wearing helmets, of course!
References
(1) Annan JD. Fundamental error in "Trends in serious head injuries..." [electronic response to Cook A, Sheikh A. Trends in serious head injuries among English cyclists and pedestrians] injuryprevention.com 2004URL direct link to eLetter
(2) Thompson DC, Rivara FP, Thompson R. Helmets for preventing head
and facial injuries in bicyclists (Cochrane Review). In: The Cochrane
Library, Issue 2, 2004. Chichester: Wiley, 2004 [http://www.Cochrane.org]
(3) Macpherson A, To T, Macarthur C, Chipman M, Wright J, Parkin P.
Impact of mandatory helmet legislation on bicycle-related head injuries in
children: a population-based study. Pediatrics 2002;110:e60
(4) Chapman G. Cycle helmets: time for a reality check [electronic response to Cook A, Sheikh A. Trends in serious head injuries among English cyclists and pedestrians] [electronic response to Cook A, Sheikh A. injuryprevention.com 2004URL direct link to eLetter
The story of seatbelts has ever been one of success - at least for
government bodies and the motor industry. However, seatbelts have an
unfortunate side effect owing to the dissipation of the kinetic and
vestibular discomfort associated with acceleration and deceleration: in
effect, faster and more erratic driving is encouraged.
Moreover, any savings in casualties among motor vehicle occupants
must be weighed...
The story of seatbelts has ever been one of success - at least for
government bodies and the motor industry. However, seatbelts have an
unfortunate side effect owing to the dissipation of the kinetic and
vestibular discomfort associated with acceleration and deceleration: in
effect, faster and more erratic driving is encouraged.
Moreover, any savings in casualties among motor vehicle occupants
must be weighed against the obvious failure of seatbelts to assist
vulnerable road-users such as pedestrians and cyclists - and hence public-
transport users, since walking and cycling are generally the most
practible modes for accessing public transport. The official attitude to
this issue - at least in the UK - has often been one of oversight, even if
the value of walking and cycling are recognised. The limited provision of
paths for the (sometimes) exclusive use of these vulnerable groups is
hardly compensation.
There is plenty of evidence to show that speeds on urban and suburban
streets - when the density of traffic permits - have steadily increased
[1], an issue for which seatbelt use cannot be absolved. Indeed, the link
between seatbelt use and increased speed was recognised by at least one
state: German seatbelt-fitted buses were permitted higher speeds than
buses without seatbelts [2].
So, happy-with-reservations 50th birthday...
References
[1] UK Department for Transport (2008). Road Safety Compliance
Consultation. London: TSO.
I read the article by Shults et al with interest.[1] State driving under the influence of alcohol (DUI) countermeasures
[2] is a rational measure but one that has serious limitations including
the confounding influence of recreational drugs, carbon monoxide, other
environmental toxins, medications and cerebrovascular diseases. The
immediate opportunity exists for implementing a far more rational an...
I read the article by Shults et al with interest.[1] State driving under the influence of alcohol (DUI) countermeasures
[2] is a rational measure but one that has serious limitations including
the confounding influence of recreational drugs, carbon monoxide, other
environmental toxins, medications and cerebrovascular diseases. The
immediate opportunity exists for implementing a far more rational and
effective measure. Optimally this would require making the passing of a
dedicated generic metabolic evaluation, combined with some form of
biometric identification of the driver, a pre-requistite for starting and
driving a car. The test could be enforced by law if the finding were also
to be recorded and the record made secure in a black box for recovery in
the event of an accident as in the airline industry.
What should be measured? I submit it is not a blood level of alcohol
or any other substance for blood levels are often dissociated from
cellular levels and the cellular effects of two or more drugs,
medications, carbon monoxide, other environmental toxins and
cerebrovascular diseases might be additive. An additonal variable is
genetically determined and acquired alterations in enzymatic activity and
hence cellular responses to these potential perturbations. It may well be
that dietary composition of both immediate and distant past meals is
another important variable for metabolic rather than absorptive reasons.
The cognitive, behavioural and functional disturbances induced by alcohol
can, therefore, be expected to vary greatly within and between individuals
with the same blood alcohol level. Those within legal limits could be
impaired and those above legal limits not.
The best measurement to make might be the intramucosal pH which may
be conveniently derived from an indirect measurement of pCO2 in the mouth
[4,5] and the arterial bicarbonate [6] or a suitable non-invasive surrogate
possibly even salivary bicarbonate. The direct measurement of sublingual
pH might even be the most suitable measurement. What makes the measurement
particularly attractive in this context is that there are good reasons to
believe that significant metabolic impairments detectable from changes in
pH might be the primary cause of avoidable accidents be they the product
of behavioural, cognitive or functional disorders.
A fall in intramucosal pH in the stomach, which has been used to
validate the sublingual measurements, is of establised predicitive value for
organ dysfunctions be they the product of alcohol, recreational drugs,
medications, myocardial infarction, dehydration, haemorrhage and/or the
systemic inflammatory response syndrome. An additional advantage of this
measurement, which could easily be repeated if a driver were to feel
unwell, would be the very early detection of serious organic disease. This
would give the driver the opportunity to stop and call for help. The
measurement might even be made continuously and linked to a hotline.
Microsensors such as the ISFET [7] and the Paratrend [8] have already
been developed that might be conveniently and inexpensively adapted for
this purpose. Before deciding whether to adopt this proposal to prevent
accidents it will, however, be necessary to perform a prospective
randomised study to establish the predictive value of these measurements
for accidents. In so doing violent behaviour could be conveniently
included as an additional end-point.[9]
References
(1) Shults R A, Sleet D A, Elder R W, Ryan G W, Sehgal M. Association between state level drinking and driving countermeasures and self reported alcohol impaired driving. Inj Prev 2002 Jun;8:106-10.
(2) Fiddian-Green R G. Delgardonian psychocivilising of the armed forces? [electronic response to Knox K L et al. Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: cohort study] bmj.com 2003 URL direct link to eLetter
(3) Fiddian-Green R G. Psychiatric aspects: an energy deficit? [electronic response to Wasserberg J. Treating head injuries] bmj.com 2002 URL direct link to eLetter
(4) Marik PE, Bankov A. Sublingual capnometry versus traditional
markers of tissue oxygenation in critically ill patients.
Crit Care Med 2003 Mar;31(3):818-22.
(6) Fiddian-Green RG. Worshipping false gods; A call to worship a new god, tissue pH; pH regulation of ATP synthase activity: evolutionary biochemical bedrock?; pH dependence of protein synthesis and cachexia; Nutrient supply dependency and the lactate shuttle hypothesis [electronic responses to Dantzker D R. Monitoring Tissue Oxygenation: The Quest Continues] Chestjournal.org 2001 URL direct link to eLetters
(7) Inoue H, Tsuchida M, Takano Y, Sato I, Sato Y, Ikegami K,
Sekiguchi T, Nagai Y. Assessment of peripheral blood perfusion during open
heart surgery with sublingual PCO2 measured by ISFET-PCO2 sensor.
Masui 2002 Oct;51(10):1155-65.
(8) Light TD, Jeng JC, Jain AK, Jablonski KA, Kim DE, Phillips TM,
Rizzo AG, Jordan MH. The 2003 Carl A Moyer Award: real-time metabolic
monitors, ischemia-reperfusion, titration endpoints, and ultraprecise burn
resuscitation.
J Burn Care Rehabil 2004 Jan-Feb;25(1):33-44.
(9) Fiddian-Green R G. A public health project worthy of massive public funding provided
the aim is not to screen for "mental illnesses" [electronic response to Lenzer J. Bush plans to screen whole US population for mental illness] BMJ 2004 URL direct link to eLetter.
Dear Editor
We thank Dr Carra for his comments[1] and we appreciate his attention to our work.[2]
Our paper was directed to a method for ranking potential safety problems that merit additional statistical and engineering review. We envisioned a surveillance process to develop a rank ordered problem list. A follow-up review process should start at the top of the problem list and work down through it,...
The article of Dr. Stevenson's is very interesting. This article showed that intervention increasing the use of safe belt. Traumatic brain injury is one of the most leading causes of death and disability in developing countries. In Indonesia, there are numerous reports that showed high mortality is correlated with unsafe practice of driving or motorcycling. Previous report showed that the use of safety belts is the single...
Dear Editor
Our critics argue two points. First, they argue that newspapers are an inappropriate source of data on defensive gun use (DGU) because editors routinely and deliberately suppress stories of legitimate DGU that involve killing or wounding or firing at an adversary. (Some of these writers also argue that brandishing a gun in self-defense is even less likely to be reported in the newspaper because these...
Several analyses of the results of bibliographic databases have shown that--for several health fields and subjects--the number of databases searched influences the number of papers found. Library and information scientists seem to use certain methods and outcomes in their analyses. I am curious whether this study used the same methods and measures.
Dear Editor
To focus on injury mitigation in cyclists to the exclusion of addressing the causes of crashes, as is the trend in public debate at present,[1] risks fundamental errors - not least the post hoc fallacy of assuming that cycling head injuries are the result of failure to wear helmets, rather than of the types of crashes cyclists experience.
As a result of this obsession we have arrived at the ab...
As noted in the recently released WHO and UNICEF World Report on Child Injury Prevention, globally, road traffic injuries (RTI) are the leading cause of death among 10-19 year-olds with more than 260,000 children dying from RTIs each year. (1) In addition, an estimated 10 million more children are non-fatally injured. Africa has the world's highest RTI mortality rate at 28.3 per 100,000 (2), yet relatively few resources...
Dear Editor
Jeffrey et al's [1] evidence of a serious underestimation of road injuries is worrying for the year-by-year comparisons that are taken as evidence for the state of road safety. The UK figures for death and serious injury are reported to have followed a downward trend for forty years or so, which has generally been taken as evidence - if no more than implicitly - that a culture of safety on the roads i...
We are grateful to Annan for spotting the arithmetic error in the discussion section of our paper of trends in cyclist head injuries.[1] It would be a mistake, however, to allow a minor mistake in the discussion to divert attention from the main finding of the paper, which was that cyclist head injuries fell during a time of increased helmet wearing. Population level time trend studies are limited in the am...
The story of seatbelts has ever been one of success - at least for government bodies and the motor industry. However, seatbelts have an unfortunate side effect owing to the dissipation of the kinetic and vestibular discomfort associated with acceleration and deceleration: in effect, faster and more erratic driving is encouraged.
Moreover, any savings in casualties among motor vehicle occupants must be weighed...
I read the article by Shults et al with interest.[1] State driving under the influence of alcohol (DUI) countermeasures [2] is a rational measure but one that has serious limitations including the confounding influence of recreational drugs, carbon monoxide, other environmental toxins, medications and cerebrovascular diseases. The immediate opportunity exists for implementing a far more rational an...
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